Basic Information
| Provider Information | |||||||||
| NPI: | 1548231723 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIDNER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LLOYD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 09/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 14612 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 4072215 | 01 | AETNA | OTHER | 510-33799 | 01 | AL | BCBS | OTHER | 111661 | 05 | AL | MEDICAID | 111667 | 05 | AL | MEDICAID | 510-49275 | 01 | AL | BCBS | OTHER | 060037259 | 01 | RAILROAD MEDICARE | OTHER | 111659 | 05 | AL | MEDICAID | 111663 | 05 | AL | MEDICAID | 510-49374 | 01 | AL | BCBS | OTHER | 510-49375 | 01 | AL | BCBS | OTHER | 000033799 | 05 | AL | MEDICAID | 510-49273 | 01 | AL | BCBS | OTHER | 515-98520 | 01 | AL | BCBS | OTHER | 111660 | 05 | AL | MEDICAID | 111665 | 05 | AL | MEDICAID | 0098921 | 01 | TN | BCBS | OTHER | 25-10159 | 01 | UNITED HEALTHCARE | OTHER | 510-49274 | 01 | AL | BCBS | OTHER | P00744573 | 01 | AL | RAILROAD MEDICARE | OTHER |